Presence of phthalate esters in intravenous solution evaluated using gas chromatography–mass spectrometry method

Di‐(2‐ethylhexyl) phthalate (DEHP) is a plasticizer widely used in the production of poly‐(vinyl) chloride (PVC) materials. It is a reproductive and developmental toxicant in animals and a suspected endocrine modulator in humans. DEHP is not covalently bound within the PVC molecule, which is why migration into a suitable medium can be expected. Since application of infusion solutions is one of the most common medical treatments, the objective of this study was to determine the migration of phthalates from softened PVC storage bags into infusion solution in different time periods within one year from date of production using a gas chromatography–mass spectrometry method. The measured values of DEHP ranged between 0.22 and 14.00 µg l^?1, but the unexpected presence of other phthalate esters was also detected. It was concluded that values obtained in infusion solutions match the reference data and represent a minor risk for the patient. The presence of other phthalate esters leads to the conclusion that the pharmacopeic requirement for polymer cleanness was not fully met. Since phthalate esters are among the most extensively used industrial chemicals and are widely distributed in the environment, special precautions and further monitoring should be conducted to minimize any possible health risks. Copyright © 2011 John Wiley & Sons, Ltd.     

A controlled study of income development for breast cancer survivors in Norway

Aims

This study seeks to assess the impact of breast cancer on survivors’ annual income at 1 to 13 years of follow-up.

Methods

A Norwegian registry-based dataset with a 13-year follow-up period was used. The dataset contained case–control pairs, where each pair consisted of one breast cancer case and a cancer-free control, matched for age, marital status, and municipality of residence. A mixed linear model was used to analyse the average income development for cases and controls adjusting for available demographic variables not used in the matching procedure, such as education level, immigration history, and number of children. Individual income was only considered relevant for cancer survivors, thus case–control pairs were censored upon death. Income development by stage of tumour at time of diagnosis was also assessed.

Results

The income of breast cancer survivors had reduced immediately following diagnosis. At 1 year after diagnosis, income development between cases and controls became significantly different (p?=?0.006). Differences increased slightly but remained significant throughout the follow-up period. At 13 years after diagnosis, the estimated cumulative income loss for survivors was 39.403 € (p?<?0.001). The income development of stage I breast cancer patients was similar to their controls. For higher stage breast cancer patients, the income differences were more pronounced but not always statistically significant.

Conclusions

Breast cancer has a significant negative effect on the individual incomes of survivors, even at 13 years after diagnosis. Effects increased for individuals with more advanced cancer stages.

Implications for Cancer Survivors

In Norway, breast cancer survivors experience lower income than their cancer-free controls. This may indicate a need for financial compensations in order to maintain the standard of living for this group of patients.     

Cord blood bilirubin and prediction of neonatal hyperbilirubinemia and perinatal infection in newborns at risk of hemolysis

ObjectiveTo assess the accuracy of umbilical cord bilirubin values to predict jaundice in the first 48 h of life and neonatal infection.MethodNewborn infants treated at a regional well-baby nursery born at ≥36 weeks of gestation were included in this retrospective cohort study. All infants born in a 3-year period from mothers with O blood type and/or Rh-negative were included and had the umbilical cord bilirubin levels measured. Hyperbilirubinemia in the first 48 h was defined as bilirubin levels above the phototherapy threshold. Neonatal infection was defined as any antibiotic treatment before discharge.ResultsA total of 1360 newborn infants were included. Two hundred and three (14.9%) newborn infants developed hyperbilirubinemia in the first 48 h of life. Hyperbilirubinemic infants had smaller birth weight, higher levels of umbilical cord bilirubin, a higher rate of infection and were more often direct antiglobulin test positive. Umbilical cord bilirubin had a sensitivity of 76.85% and a specificity of 69.58% in detecting hyperbilirubinemia in the first 48 h, with the cut-off value at 34 μmol/L. The area under the receiver operating characteristic curve was 0.80 (95% CI: 0.78–0.82). Umbilical cord bilirubin had a sensitivity of 27.03% and specificity of 91.31% in detecting perinatal infection. The area under the receiver operating characteristic (ROC) curve was 0.59 (95% CI: 0.57–0.63).ConclusionsA positive correlation was found between umbilical cord bilirubin and hyperbilirubinemia in the first 48 h of life. Umbilical cord bilirubin is a poor marker for predicting neonatal infection.     

Re-expansion pulmonary oedema—fatal complication of mediastinal tumour removal

We report a case of re-expansion pulmonary oedema (RPE) occurring after a mediastinal tumour removal procedure. RPE is a rare complication associated with the treatment of a collapsed lung caused by pneumothorax, pleural effusion or tumour. The risk factors are a longer period (more than three days) of collapsed lungs, the volume of intrathoracic lesion, loss of surfactant and the patient's age. Treatment of RPE is difficult due to there being no clear pathophysiology, and is associated with high mortality. Careful management and clinical guidelines are needed to render the therapy more effective.     

Comparison of HPV detection rate in formalin-fixed paraffin-embedded tissues of head and neck carcinoma using two DNA extraction kits and three amplification methods

The potential problems of DNA extraction from formalin-fixed paraffin-embedded (FFPE) tissue samples and amplification efficiency of Human papilloma virus (HPV) may occur in the molecular studies of head and neck squamous carcinoma (HNSCC). The aim of this study was to compare HPV detection rate in FFPE tissues of oral, oropharyngeal, hypopharyngeal, and laryngeal cancers using two silica-based extraction kits and three amplification methods. A total of 50 FFPE specimens from HNSCC tissues were analyzed. The quality and quantity of the extracted DNA were tested by spectrophotometry. HPV DNA was detected using a single polymerase chain reaction (PCR), a nested PCR, and a Real-time PCR kit. Statistically significantly higher DNA quality and quantity was observed using the QIAamp DNA FFPE Tissue Kit than when using the QIAamp DNA Mini Kit. There was not HPV amplification in any of the 50 FFPE samples using the single PCR and Real-time PCR kits, whereas HPV DNA was detected in 22% of samples using nested PCR. Comparing results of the three different methods showed that HPV DNA was detected only with nested PCR. The results presented imply that nested PCR is the most appropriate method for the detection of HPV DNA in FFPE samples, along with adequate DNA extraction methods.     

Tetralogy of Fallot with Cor Triatriatum Dexter in an Adult Patient: A Case Report

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect with only approximately 3% of uncorrected patients surviving past age 40. In this case report, we present a 48‐year‐old mentally retarded man suffering from congenital spastic quadriplegia who was diagnosed with a unique combination of symptomatic TOF and cor triatriatum dexter (CTD). Reduced preload because of CTD with spastic quadriplegia that prevented physical exertion is believed to have facilitated this patient's unusually long survival.     

Air Pollution Study in Croatia Using Moss Biomonitoring and ICP–AES and AAS Analytical Techniques

Moss biomonitoring technique was applied in a heavy-metal pollution study of Croatia in 2006 when this country participated in the European moss survey for the first time. This survey was repeated in 2010, and the results are presented in this study. For this purpose, 121 moss samples were collected during summer and autumn 2010. The content of 21 elements was determined by inductively coupled plasma–atomic emission spectrometry and atomic absorption spectrometry. Principal component analyses was applied to show the association between the elements. Six factors (F1–F6) were determined, of which two are anthropogenic (F3 and F6), two are mixed geogenic–anthropogenic (F1 and F5), and two are geogenic factors (F2 and F4). Geographical distribution maps of the elements over the sampled territory were constructed using geographic information systems technology. Comparison of the median values of some of the anthropogenic elements—such as arsenic, cadmium, chromium, copper, mercury, nickel, lead, vanadium, and zinc—with those from the 2006 study shows that anthropogenic pollution has changed insignificantly during the last 5 years. The data obtained in the investigation in Norway are taken for comparison with pristine area, which indicates that Croatia is somewhat polluted but still, shows a more favourable picture when compared with two neighbouring countries.     

Ventricular septal rupture with hemodynamically important left-to-right shunt,right ventricular myocardial infarction,transient type III atrioventricular block and the development of left ventricular aneurysm as a complication of sub-acute myocardial infarction of the bottom wall accompanied by post-infarction unstable angina pectoris

Ventricular septal rupture is a serious mechanical complication of myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. We report the case of a patient with acute inferior myocardial infarction and a ventricular septal rupture with early diagnosis based on clinical examination and transthoracic echocardiography and postponed successful surgical correction.     

Distribution of CFTR mutations in the Czech population: Positive impact of integrated clinical and laboratory expertise,detection of novel/de novo alleles and relevance for related/derived populations

BackgroundThis two decade long study presents a comprehensive overview of the CFTR mutation distribution in a representative cohort of 600 Czech CF patients derived from all regions of the Czech Republic.MethodsWe examined the most common CF-causing mutations using the Elucigene CF-EU2v1? assay, followed by MLPA, mutation scanning and/or sequencing of the entire CFTR coding region and splice site junctions.ResultsWe identified 99.5% of all mutations (1194/1200 CFTR alleles) in the Czech CF population. Altogether 91 different CFTR mutations, of which 20 were novel, were detected. One case of de novo mutation and a novel polymorphism was revealed.ConclusionThe commercial assay achieved 90.7%, the MLPA added 1.0% and sequencing increased the detection rate by 7.8%. These comprehensive data provide a basis for the improvement of CF DNA diagnostics and/or newborn screening in our country. In addition, they are relevant to related Central European populations with lower mutation detection rates, as well as to the sizeable North American “Bohemian diaspora”.